The International Society for
Disease Surveillance maintain as website
which charts Emergency Department influenza-like illness (ILI) visits
for all regions in the US, including additional data for individual
states and localities. The chart for
Region III has a sharp uptick in cases for the past two reporting weeks
to levels seen in early 2011. This spike was not seen in charts
from PA, MD, VA, indicating the sharp increase was concentrated in the
three remaining regions (DE, WV, DC).

This week Delaware
reported a sharp
increase in Tamiflu resistant H1N1, raising concerns that such
cases were causing severe disease. There were eight such cases
reported in the past week, with hospitalization status given for four
of the cases. Three of the four had been hospitalized
and one died, raising concerns that the Tamiflu resistant (H274Y)
H1N1 was causing severe disease.

Sequence data for the
first three cases in Delaware indicated the HA had S188T and A189T
signaling recombination between two dominant sub-clades. A189T is
present in the Chihuahua sub-clade, which has been identified in
Maryland and that isolate, A/Maryland/04/2011, was Tamiflu resistant.

Collection dates on the
eight cases reported in the past week, as well as sequence data for
these cases and H274Y cases in adjacent states, including Maryland,
would be useful.